Recent Engagements

We helped a provider-based managed care organization recruit and contract with a sufficient number of hospitals, physicians and ancillary providers allowing it to file for an SNP license with CMS in a specific County of New York City.

We are assisting a Medicaid managed care organization recontract with a large number of its participating hospital providers. The purpose of the recontracting is to update its contract language so that it is consistent with State-mandated contract provisions.

Working off of a targeted physician recruitment list of over 10,000 physicians, we are engaged in a physician recruitment effort in the States of California, North Carolina, Massachusetts and New Hampshire. This work is being done to enhance the competitive value of the physician network for a large national health plan.

We have been engaged to review the claims file of a large national health plan for purposes of confirming the relative competitive positions of their facility payment rates in the State of New Jersey. Through an electronic downloading procedure, we were able to analyze the needed information securely and expeditiously.

A national Medicaid managed care organization has engaged us to help them recruit a sufficient number of physicians in the State of New Jersey so that they can satisfy the State-mandated distribution of physician specialties by County and to also help to make their Medicare managed care program more marketable.

A large national health plan has engaged us to help them to expand their physician network in the State of New Jersey t make the network competitive with the market.

We are currently providing managed care contracting support to a hospital system, a number of individual hospitals, nursing homes, home health care agencies, imaging centers and ambulatory surgery centers. This support runs the gamut of negotiating increased rates to providing detailed analytical and ‘what if’ modeling to identifying payments at less than agreed upon rates to physician credentialing.

We assisted a national Medicaid managed care plan entering the New York metro market by developing a tri-county hospital and physician network. We helped to recruit 1,300 physicians (primary & specialty) in 90 days. The client completed a successful IPO and is in the final stages of applying for licensure in New York State.

We contracted radiology, anesthesiology, and pathology groups (RAPs) in New York and New Jersey for a major national HMO client. This project has reduced out-of-network spending by 20%.

We were engaged by a local nurse placement agency to assist in structuring a foreign nurse recruitment program and in marketing their services to hospitals and other health care facilities in the U.S.

We were engaged by a Medicare Managed Care Plan to develop a revised provider relations manual and a carve-out vendor performance measurement tool. This effort will allow the client to negotiate more favorable renewals with the carve-out vendor network.

We conducted a physician marketing effort for a national provider of secure online health care communication services to support online medical consultations between physician subscribers and patients. This effort has allowed the client to rapidly increase physician recruitment into their program.

We helped a Michigan-based health plan initiate a physician re-contracting effort. This effort allowed the client to improve business relationships with a local IPA.

We assisted a large national managed care plan to negotiate a contract rate renewal for a multi-hospital system in NY. We recruited 3,500 non-participating physicians into their provider network, resulting in significant reductions in out-of-network spending and helping to control claim cost trends.

We negotiated hospital rates and contracts among New York hospitals and IPAs for a regional HMO. This assignment allowed the New Jersey members of the health plan to have “in network” access to quality New York tertiary care facilities.

We planned and developed an organizational structure, marketing programs and a provider network for a start-up MCO. This project successfully contracted with over 35,000 physicians, 1,250 ancillaries, and 256 hospitals and increased membership to over 800,000 throughout New York and New Jersey.

We conducted outbound data verification program for a national MCO while introducing the use of web-based tools. The project realized a 100% success rate targeting network physicians throughout the Northeast.

We perform outsourced credentialing services at Skilled Nursing Facilities and Ambulatory Surgery Centers for a major health insurer. This service enabled our client to maintain accredited providers and continue to meet NCQA Standards.

We built a hospital and physician network for a local CMS-certified Provider Sponsored Organization to expand in the Albany, NY area. This effort allowed the client to file for expansion of its Medicare PSO license by the CMS filing deadline.